Provider Demographics
NPI:1003418542
Name:VIRGINIA VISION CARE ASSOC., L.L.C.
Entity Type:Organization
Organization Name:VIRGINIA VISION CARE ASSOC., L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EWING
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCCLELLAND
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:720-825-3554
Mailing Address - Street 1:2416 PURDUE RD
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-1711
Mailing Address - Country:US
Mailing Address - Phone:970-825-3554
Mailing Address - Fax:
Practice Address - Street 1:102 W MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-2823
Practice Address - Country:US
Practice Address - Phone:970-407-0665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO33756236Medicaid